Bathrooms
Physical supports – key to creating bathrooms that aid stroke rehabilitation is the adoption of bathroom design that provides physical support. If a bathroom contains a floor standing bathroom unit, this is likely to be used to lean on when the resident feels weak or unsteady. As a result, it is critical that all furniture and items installed in the space are strong enough to withstand the weight of a person and are stable enough to stay upright and not tip – especially if they are pushed on with only one hand. Logical layout – repetition is one of a stroke survivor’s greatest tools in relearning behaviours that allow them to be independent. As a result, keeping products in the most logical places and in the areas where anyone would expect to find them naturally – for instance, keeping shower gel in the shower and soap on the basin – will allow users, particularly those with apraxia, to understand what the items are for and enable them to carry out the tasks for themselves automatically, which is a vital part of rehabilitation. Keeping it simple - remove anything in a room that is not necessary. Clutter and redundant objects or pieces of furniture will serve only to make the environment more challenging and overwhelming for the stroke survivor. The only things that should be in the room are the objects and products that the user will need on a daily basis. Equally, keep patterned surfaces to an absolute minimum to minimise confusion for the resident when navigating the space. It is also worth noting that these principles for making the bathroom environment a user-friendly space for someone who is post-stroke also make it easier to use for people living with arthritis, dementia, and other neurological conditions.
Specific bathroom design guidance for stroke survivors Wash basins – these should always be fixed securely to a wall and not freestanding. Similarly, towel rails need to be strong and fixed to the wall for the same reason. Fold up grab rails – combined with toilet roll holders, these are an ideal way to maximise space, whilst offering even more stability aids for a stroke survivor. The grab rails should be installed on both sides of any furniture and need to be of the type that they can be put away against the wall if needed, allowing greater access around the space.
Taps – the needs of the individual will dictate the choice of taps. For example, for a stroke survivor with paralysis on one side, a mixer tap would be a better choice as this can be operated with one hand, however for someone with significant cognitive damage, a mixer tap is more confusing than two separate taps.
Underfloor heating – to avoid exposed
pipework and radiators, underfloor heating is ideal. Opt for low surface temperature radiators if underfloor heating is not possible however, so that burn injuries are prevented. Flooring – non-slip flooring is essential and patterns or flecks should be avoided, as these can be visually challenging for those with cognitive damage or visual impairments. Tiling – muted colours and patterned tiles are best avoided as these can cause visual confusion. Contrast can be used however to distinguish between different surfaces. Showers – the controls need to be simple to understand and easy to use with one hand operation. There should also be obvious up and down buttons for temperature and flow control.
One of the most complex areas for stroke survivors to negotiate is the bathroom. Typical issues for stroke survivors when using the bathroom can include difficulty in transferring on and off the toilet, or getting in and out of baths and showers, as well as altered visual perception and feeling overwhelmed or psychologically confused.
Bathroom accessibility for those with visual impairments Another group of residents who can find it difficult to maintain a level of bathroom independence are those who have some form of visual impairment. It is estimated that one in two people living in care homes has some degree of sight loss, and a Thomas Pocklington Trust report2 on older people’s experiences of sight loss in care homes has found that: n Residents in care homes often have complex needs, and as well as visual impairment may also have other health issues such as hearing loss, memory loss and confusion, mobility difficulties, poor mental health, or depression.
n The transition of moving into a care home can be difficult. Adjusting to a new environment when living with sight loss requires support.
n Residents’ quality of life is positively affected by: n Greater awareness about what it means to live with sight loss, particularly from staff but also amongst other residents.
n Support from family, friends, and staff. Relationships with others are crucial in counteracting feelings of isolation. Having time to talk with staff and having company is vital.
n More knowledge about available aids and technology is needed to help residents with sight loss maintain their interests or develop new ones.
n Better connections with local external organisations such as sight loss societies and rehabilitation services.
July 2024
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